Provider Demographics
NPI:1669918702
Name:WALTON, KELLEY (MS, SLP-CCC)
Entity type:Individual
Prefix:MISS
First Name:KELLEY
Middle Name:
Last Name:WALTON
Suffix:
Gender:F
Credentials:MS, SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2811 ROOSEVELT DR
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-8946
Mailing Address - Country:US
Mailing Address - Phone:724-972-5064
Mailing Address - Fax:
Practice Address - Street 1:2397 LOOP RD
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17202-8847
Practice Address - Country:US
Practice Address - Phone:717-816-0742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL013286235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist